A Community Assessment Tool to Measure Syringe Access Readiness

Harm Reduction Coalit ion (HRC)

Narelle El lendon, RN

Katie Burk, MPH 1

Overview of the Harm Reduction Coalition and CBA for SAS Mobilization team

Reviewing Syringe Access Services (SAS) in the US

Defining the A PLACE model

Applying the A PLACE model to community assessment work

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Harm Reduction Coalition

Founded in 1994 to work with individuals and communities at risk for HIV infection due to drug use and high-risk sexual behaviors.

The Harm Reduction Coalition is a national advocacy and capacity-building organization that promotes the health and dignity of individuals and communities impacted by drug use.

The Institute @HRC ◦ Capacity Building for Syringe Access Services Mobilization ◦ HIV Prevention Capacity Building Initiative for CBOs ◦ Harm Reduction Training Institute ◦ Overdose Prevention Programs (SKOOP/DOPE) ◦ LGBT Project

Policy Advocacy

National and Regional Conferences ◦ Next National Conference: Portland, Oregon in Nov. 2012 ◦ Harm Reduction in The South; NC Sept 2011

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Provide technical assistance to Community Based Organizations, Health Departments and Communities to address IDU (Injecting Drug Users) Health Needs, including HIV Prevention.

Provide expertise to: Establish, Expand & Improve Effectiveness of Syringe Access

Services (SAS)

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Syringe access programs are the most effective, evidence-based HIV prevention tool for people who use drugs.

Seven federally funded research studies found that syringe exchange programs are a valuable resource.

In cities across the nation, people who inject drugs have reversed the course of the AIDS epidemic by using sterile syringes and harm reduction practices.

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Every year 32,000 people get infected with HIV/AIDS and Hepatitis C in the US by sharing contaminated syringes(1).

Nationally, injection drug users

represent 12 % of annual HIV infections and 19 % of people living with HIV/AIDS.

1) Drug Policy Alliance, http://www.drugpolicy.org/facts/drug-war-numbers

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Significant shifts toward support of syringe access programs on a federal level:

Lift of the federal ban in 2009 ◦ Federal funds can now be used to directly support

syringe access programs

National HIV/AIDS Strategy (NHAS) 2010 ◦ Calls for minimizing HIV infection among IDUs ◦ Specifically sites syringe exchange as an intervention

that will reduce the HIV infection rate among IDUs

National Hepatitis plan 2011 ◦ Call to enhance IDU access to sterile syringes Sources: http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf, http://www.hhs.gov/ash/initiatives/hepatitis/actionplan_viralhepatitis2011.pdf

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Nat

iona

l HIV

/AID

S St

rate

gy • Intensify prevention

efforts in communities where HIV is most heavily concentrated

•Expand efforts to prevent HIV using evidence based approaches •Promote a holistic

approach to health that addresses comorbidities with STDs and hepatitis C

HH

S he

patit

is a

ctio

n pl

an •Mobilize community

resources to prevent viral hepatitis caused by IDU

•Ensure that IDUs have access to hepatitis prevention services

•Provide IDUs with access with access to care and SA treatment to prevent transmission and disease progression CB

A fo

r SA

S M

obili

zatio

n •Mobilize communities to provide effective SAS (an evidence-based intervention) •Establish/Expand SAPs

to provide HIV testing, linkages to SA tx, hepatitis education and screening, medical care •Build leadership,

alliances, community awareness

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Reducing new infections ◦ Main focus of CBA for SAS Mobilization

Access to care and improving health outcomes ◦ Support people living with HIV with co-occurring health

conditions and those who have challenges meeting their basic needs, such as housing.

Reducing HIV disparities and health inequities ◦ Adopt community level approaches to reduce HIV

infection in high-risk communities

More coordinated national response to the HIV epidemic ◦ Increase the coordination of HIV programs across

federal, state, and local governments

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Develop Community Mobilization Model

(A PLACE)

Identify services to provide, recipients of services, process, and outcomes

Provide trainings and TA to targeted communities

Increased utilization of SAS should emphasize other services related to

prevention 12

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•AWARENESS

A

•POLICY P

•LEADERSHIP L

•ALLIANCES A

•CULTURE C

•ESTABLISH/EXPAND E 14

Build and/or Expand :

Community AWARENESS of the need for SAS

Understanding around POLICY issues that impact SAS

LEADERSHIP to champion SAS

ALLIANCES that support and aid the establishment & expansion of SAS

IDU CULTURAL competency of SAS

Capacity to ESTABLISH SAS

SAS capacity to EXPAND to meet IDU health needs

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• AWARENESS A What is the existing level of community awareness around HIV & HCV transmission among IDUs?

How does the community regard SAS as an intervention for their jurisdiction?

How does the community obtain information about IDU health issues?

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What are the current policies that impact SAS? Are any advocates or groups working on SAS-related policy? How does the community perceive & implement these policies?

• POLICY P

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Who are the leaders who work to address IDU health issues?

What are the capacity needs of leadership to address the needs of new or existing SAS?

• LEADERSHIP L

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What alliances address HIV or HCV prevention, IDU issues, and/or SAS?

Who are the constituents of the alliances?

What are the capacity needs of alliances to address and/or champion SAS?

• ALLIANCES A

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How do agencies or programs meet IDU health needs?

In what ways do new or existing SAPs and other programs promote consumer involvement?

What data/research/evaluation is available to assess IDU needs and effectiveness of services?

•CULTURAL COMPETENCY C

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What are the capacity needs to establish SAS?

In what ways do can existing SAS be improved to better meet the needs of IDUs?

• ESTABLISH/EXPAND E

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Leveraging the strengths of…

Communities

Leaders

Advocates

Programs

Alliances

in order to address barriers to SAS.

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E

State of SAP Obstacles

Al.

C

L

Aw.

P

E

Al.

P

C

L

Aw.

GO

AL G

OA

L

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Key informant interviews

Surveys

Strategic planning processes

Expansion of existing needs assessment processes

Support for community coalitions

Focus groups

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Applying the needs assessment model to the jurisdictions in the CBA for SAS Mobilization team’s work plan

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5 new pilot SAPs in the state

Leadership in 5 programs to form an alliance, become HR experts in NJ

CBA for SAS facilitating planning process for Harm Reduction Partnership of NJ (HRPNJ)

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Key informant interviews with 6 leaders of the 5 NJ-based SAPs

Interviews transcribed

Qualitative analysis of data by CBA for SAS Mobilization team

SWOT analysis employed with results of qualitative data

Report drafted on interviews and SWOT analysis, disseminated to HRPNJ

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Guiding HRPNJ’s strategic planning process:

Solidify and expand alliance (HRPNJ)

Increase awareness of law enforcement

Improve IDU cultural competency of programs ◦ Create more avenues of consumer involvement at SAPs ◦ SAPs as leader/model of IDU cultural competency for

other local programs

Expand reach of existing programs ◦ Expand hours, other program models ◦ Providing OD Prevention, hepatitis education, food

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Improving drug user cultural competency—CBA activities ◦ Drug User Stigma training ◦ Syringe Access and Law Enforcement training ◦ Focus groups at 2 sites

Strengthening alliances—Creation of policy and procedures, bylaws for HRNJP

Focusing on awareness of program and its usefulness (working with law enforcement)

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Boulder has 3rd oldest program in US, had been operating under the radar before legislation passed

Recent SAS legislation passed statewide, called for local buy-in

Restrictive city ordinance in Denver posing barriers to establishment of SAP

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Syringe access affinity session during APHA conference in Denver, Nov 2010

Key informant interviews with 6 key informants who are involved with IDU-related serviced in CO

Interviews transcribed

Qualitative analysis of data by CBA for SAS Mobilization team

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Political and legislative barriers

Limited cross-jurisdictional support among programs working with IDUs

Strong leadership in harm reduction field and IDU health

Impressive IDU cultural competency of programs

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City ordinance in Denver amended, RFP released

Building capacity of leaders

Boulder to advocate for Narcan availability

Strong cross-jurisdictional alliance between Boulder, Denver, Fort Collins

Trainings on Drug User Stigma, Building Alliances between SAPs and Law Enforcement, Improving Health with Drug Users

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Interest in initiating SAS among county health department staff in Washoe County

NV-based needs assessment processes pointing to need for SAS

No legal or underground SAPs, no enabling legislation

CBA for SAS working to support IDU CC, community awareness, leadership

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Syringe access legislation did not pass in 2011

Before next political process an establishment of the program, need to build up… ◦ SAS leadership ◦ Alliances ◦ IDU cultural competency ◦ Awareness of the

effectiveness of SAS

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Limited SAS, high rates of HIV incidence and prevalence

Legislation restricting SAS in many states

Lack of awareness, IDU cultural competency, alliances & leadership on drug user health issues

Pockets of effective harm reduction advocates and providers in different parts of the region.

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Focus on building awareness, alliances, and IDU cultural competency:

◦ Southern Network google group

◦ Southern HR Conference Sept 2011

◦ Collaborating with agencies also doing work in the South (LCOA, ACRIA)

◦ Supporting & showcasing working models of SAS in the South (NCHRC, AHRC)

◦ Building our understanding of Southern drug user community issues to provide specific SAS CBA jurisdiction work

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Syringe Access Community Mobilization http://www.harmreduction.org/article.php?id=1146

Narelle Ellendon (NYC) ellendon@harmreduction.org 212 213 6376 x16

Katie Burk (Oakland) burk@harmreduction.org 510 444 6969 x13

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